PCMHI

[BuckeyeLove]

This topic seems to have run its course, so I will stray off topic and just say that I agree with this sentiment so much. Psychology needs to better define scope of practice and protect its turf instead of relying on the notion that we to the same thing better (and for more money). While I think those of us who are a bit older are safe, I am curious to see how budgetary restrictions may impact this in the future. Many non-VA health systems already use mid level providers for this purpose.

I don't work for the VA, but with my one government job, there definitely appears to be some form of conflict between administration and staff psychologists (ESPECIALLY with the ones that don't do evaluations). All in all, it seems that administration tends to think that a. we are overpaid/glorified social workers, b. we're all narcissistic , and c. they would rather have mid-levels because they tend to (from my small limited sample size) be easier to control/don't fight back/are happy to just have a job. I will say, this appears to be circumscribed only to my facility, as other facilities in my system still view psychology as an integral part of the teams.

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[Sanman]

I don't work for the VA, but with my one government job, there definitely appears to be some form of conflict between administration and staff psychologists (ESPECIALLY with the ones that don't do evaluations). All in all, it seems that administration tends to think that a. we are overpaid/glorified social workers, b. we're all narcissistic , and c. they would rather have mid-levels because they tend to (from my small limited sample size) be easier to control/don't fight back/are happy to just have a job. I will say, this appears to be circumscribed only to my facility, as other facilities in my system still view psychology as an integral part of the teams.

I believe it. Then, the question then becomes do we want our ability to earn a living to be based on what an administration, the public, managed care, etc thinks of us or because we are the only legal avenue to provide the service? Admins can think the same thing about a surgeon, but when someone needs their gall bladder removed...

 

[WisNeuro]

Agreed, this is why I have spent a good deal of my time developing knowledge and completing decisional capacity evaluations as part of my previous job (specifically geriatric decisional capacity in my case). Not something that can be easily taken away from us by mid-levels and it may be where I focus my PP efforts in the future.

To be honest, though, the majority of these evals should be done by the immediate treatment team. We should be brought in in the tough cases, or in consultation. Anecdotally, 90% of my consults for this were painfully clear after chart review and about 2 mins of conversation.

 

[Sanman]

To be honest, though, the majority of these evals should be done by the immediate treatment team. We should be brought in in the tough cases, or in consultation. Anecdotally, 90% of my consults for this were painfully clear after chart review and about 2 mins of conversation.

True for medical issues, though I was often consulted to do them by physicians who did not want to waste their time or needed a second signature and there was no other physician on staff at a SNF. For PP, I am more interested in getting into the legal consults rather than medical.

 

[WisNeuro]

True for medical issues, though I was often consulted to do them by physicians who did not want to waste their time or needed a second signature and there was no other physician on staff at a SNF. For PP, I am more interested in getting into the legal consults rather than medical.

Yes, I'll gladly do these at a forensic rate 5X+ my clinical rate. More than happy to. But, in my clinical practice, I try not to reinforce laziness on part of the MDs. Sometimes it's clear that they want the pt to not have capacity when they clearly do, in which case I'll see it for the pts sake, but otherwise I offer to consult with them over the phone.

 

[Sanman]

Yes, I'll gladly do these at a forensic rate 5X+ my clinical rate. More than happy to. But, in my clinical practice, I try not to reinforce laziness on part of the MDs. Sometimes it's clear that they want the pt to not have capacity when they clearly do, in which case I'll see it for the pts sake, but otherwise I offer to consult with them over the phone.

Fair enough, but you are at a SNF at the pleasure of the Exec. Director and Medical Director. When the choice is piss off sole referral source or see the patient to make them happy and make money... I go with the latter.

 

[WisNeuro]

Fair enough, but you are at a SNF at the pleasure of the Exec. Director and Medical Director. When the choice is piss off sole referral source or see the patient to make them happy and make money... I go with the latter.

Ah, that may not be the workplace for me.

 

[Sanman]

Ah, that may not be the workplace for me.

It is not the workplace for a lot of people, but the few that navigate the system and take all the work make a fortune. There are not that many players in the space given the amount of work.

 

[AcronymAllergy]

It is not the workplace for a lot of people, but the few that navigate the system and take all the work make a fortune. There are not that many players in the space given the amount of work.

I think SNF and ALF work could be areas in which psychologists, given our varied skillset, are uniquely trained to do well in certain capacities. Unfortunately, the positions also often seem to be underfunded and/or overworked, and the one or two pitches I've heard implied or outright asked me to do things with which I would not have at all been comfortable (e.g., make medication recs to the primary care docs). But it sounds like you've found a pretty sweet gig.

 

[Sanman]

I think SNF and ALF work could be areas in which psychologists, given our varied skillset, are uniquely trained to do well in certain capacities. Unfortunately, the positions also often seem to be underfunded and/or overworked, and the one or two pitches I've heard implied or outright asked me to do things with which I would not have at all been comfortable (e.g., make medication recs to the primary care docs). But it sounds like you've found a pretty sweet gig.

It is a huge growth area, particularly SNF work, because mid level therapists are legally barred from billing psychotherapy services in SNF facilities. Hence all the recruiting that goes on in that area. The problem is that private equity backed companies have taken over a lot of the contracts and are trying to drive smaller clinician owned practices out of business.

Personally, I worked at a large company, then moved to a small group with more opportunities for advancement, then off to the VA when I felt I was not getting compensated well enough for the work I brought to the table. The money is there, it is simply that those at the top often do not feel like sharing it (they offer most people less than 50% of billables). Same as with a lot of large outpatient practices. I took the time to learn the ropes (business-wise), so I would be able to do my own thing in the future. My VA gig is very low stress and pretty good for my current life stage (working on that starting a family thing). Eventually, I will go PP or just get out of clinical work altogether. We will see.